İlkay BARAN, MENEKŞE OKŞAR, Savaş ALTINSOY

Retrograt İntrarenal Cerrahi Geçiren Hastalarda Nöromuskuler Ajan Kullanımının Postoperatif Titreme Üzerine Etkisi: Randomize Kontrollü Klinik Çalışma

Amaç: Titreme ve aktif hareket bilinci açık ve hareket edebilen hastalarda ısı üretimi ve ısınma için çok etkin bir mekanizmadır. Bu çalışma, genel anestezi sırasında kas gevşetici (KG) kullanılan erişkinlerde intraoperatif hipotermi ve buna bağlı postoperatif titreme olabileceği hipotezini test etmeyi amaçlamıştır. Yöntem: Retrograd intrarenal cerrahi (RIRS) geçirecek 80 hasta rastgele kas gevşetici (KG) kullanılan (Grup R, N=40), KG kullanılmayan (Grup K, N=40) olarak iki gruba ayrıldı. Tüm hastalara hava yolu kontrolü için Laringeal Maske (LMA) kullanıldı ve KG verilmesi dışında, standart bir anestezi protokolü uygulandı. Cilt ve iç sıcaklıklarının monitörizasyonlarından elde edilen veriler ve titreme muayeneleri anestezi indüksiyonundan önce (t0), KG verildiğinde (t1 ), intraoperatif 15 (t2 ), 30 (t3 ), ve 60 (t4 ) ve postoperatif 0 (t5 ), 10 (t6 ), 15 (t7 ), 30 (t8 ), 60 (t9 ) dk.’larda kaydedildi. Bulgular: Grup R’de t0 , t1 , t2 , t3 ve t5 cilt ısısı Grup K’den anlamlı derecede yüksek iken iç sıcaklıklar bakımından gruplar arasında fark yoktu. (t5 , t6 ve t7 ’de titreme olanların oranı Grup R’de Grup K’den anlamlı derecede fazla idi (p

The Effect of Neuromuscular Agent on Postoperative Shivering in Patients Undergoing Retrograde Intrarenal Surgery: A Randomized Controlled Clinical Trial

Objective: Shivering, and active movements, are very effective mechanisms for heat generation and warming in ambulatory mobile patients with open conscious. This study aimed to test the hypothesis that intraoperative hypothermia and postoperative shivering may be present in adults for whom neuromuscular blocker (NMB) was used during general anesthesia. Method: Eighty patients who underwent retrograde intrarenal surgery (RIRS) were randomly divided into two groups as those receiving or not receiving neuromuscular blocking agent (NMB) [Group R (NMB+), N=40; Group K (control), N=40)]. Laryngeal mask (LMA) was used for airway control in all patients and a standard anesthetic protocol was performed except for NMB administration. Data obtained from the monitoring of skin and internal temperatures and shivering tests were performed prior to anesthesia induction (t0), when NMB was delivered (t1 ), intraoperative 15 (t2 ), 30 (t3 ), and 60 (t4 ) and postoperative 0 (t5 ), 10 (t6 ), 15 (T7 ), 30 (t8 ), and 60 (t9 ) minutes. Results: In group R, at t0 , t1 , t2 , t3 and t5 skin temperatures were significantly higher than group K, but there was no difference between the groups in terms of internal temperatures (t5 , t6 and t7 in those who have tremors in group R were significantly higher than group K (Chi-Square p

PDF

___

Zafren K, Giesbrecht GG, Danzl DF, et al. Wilderness Medical Society practice guidelines for the out-ofhospital evaluation and treatment of accidental hypothermia: 2014 update. Wilderness & Environmental Medicine. 2014;25:S66-85. https://doi.org/10.1016/j.wem.2014.10.010
Eberhart LH, Döderlein F, Eisenhardt G, et al. Independent risk factors for postoperative shivering. Anesth Analg. 2005;101:1849-57. https://doi.org/10.1213/01.ANE.0000184128.41795.FE
Buggy DJ, Crossley AW. Thermoregulation, mild perioperative hypothermia and postanaesthetic shivering. Br J Anaesth. 2000;84:615-28. https://doi.org/10.1093/bja/84.5.615
Crossley AW. Six Months of shivering in a district general hospital. Anaesthesia. 1992;47:845-8. https://doi.org/10.1111/j.1365-2044.1992.tb03143.x
Hoshijima H, Takeuchi R, Kuratani N, et al. Incidence of postoperative shivering comparing remifentanil with other opioids: a meta-analysis. J Clin Anesth. 2016;32:300-12. https://doi.org/10.1016/j.jclinane.2015.08.017
Sankar-Maharaj S, Chen D, Hariharan S. Postoperative shivering among cannabis users at a public hospital in Trinidad, West Indies. J Perianesth Nurs. 2018;33:37-44. https://doi.org/10.1016/j.jopan.2016.03.010
Sessler DI, Rubinstein EH, Moayeri A. Physiologic responses to mild perianesthetic hypothermia in humans. Anesthesiology. 1991;75:594-610. https://doi.org/10.1097/00000542-199110000-00009
Horn EP, Werner C, Sessler DI, et al. Late intraoperative clonidine administration prevents postanesthetic shivering after total intravenous or volatile anesthesia. Anesth Analg. 1997 Mar;84(3):613-7.
Röhm KD, Riechmann J, Boldt J, et al. Total intravenous anesthesia with propofol and remifentanil is associated with a nearly twofold higher incidence in postanesthetic shivering than desflurane-fentanyl anesthesia. Med Sci Monit. 2006;12:CR452-56.
Bal NC, Marya SK, Sapariwala DH, et al. Sarcolipin is a newly identified regulator of muscle-based thermogenesis in mammols. Nat Med. 2012;18:1575-9. https://doi.org/10.1038/nm.2897
Choi KE, Park B, Moheet AM, et al. Systematic Quality Assessment of Published Antishivering Protocols. Anesth Analg. 2017;124:1539-46. https://doi.org/10.1213/ANE.0000000000001571
Frank SM, Fleisher LA, Olson KF, et al. Multivariate determinants of early postoperative oxygen consumption in elderly patients: effects of shivering, body temperature, and gender. Anesthesiology. 1995;83:241-9. https://doi.org/10.1097/00000542-199508000-00002
De Witte J, Sessler DI. Perioperative shivering: Physiology and pharmacology. Anesthesiology. 2002;96:467-84. https://doi.org/10.1097/00000542-200202000-00036
Park SM, Mangat HS, Berger K, et al. Efficacy spectrum of antishivering medications: Meta-analysis of randomized controlled trials. Crit Care Med. 2012;40:3070-82. https://doi.org/10.1097/CCM.0b013e31825b931e
Hoffman J, Hamner C. Effectiveness of dexmedetomidine use in general anesthesia to prevent postoperative shivering: a systematic review. JBI Database System Rev Implement Rep. 2016;13:287-313. https://doi.org/10.11124/jbisrir-2015-2257
Park B, Lee T, Berger K, et al. Efficacy of Nonpharmacological Antishivering Interventions: A Systematic Analysis. Crit Care Med. 2015;43:1757-66. https://doi.org/10.1097/CCM.0000000000001014
Woolnough M, Allam J, Hemingway C, et al. Intraoperative fluid warming in elective caesarean section: a blinded randomised controlled trial. Int J Obstet Anesth. 2009;18:346-51. https://doi.org/10.1016/j.ijoa.2009.02.009
Goyal P, Kundra S, Sharma S, et al. Efficacy of intravenous fluid warming for maintenance of core temperature during lower segment cesarean section under spinal anesthesia. J Obstet Anaesth Crit Care. 2011;1:73-77. https://doi.org/10.4103/2249-4472.93990
Giesbrecht GG. Cold stress, near drowning and accidental hypothermia: A Review Aviat Space Environ Med. 2000;71:733-52.